What you need to know
Extras health insurance gives you a yearly benefit for treatments like optical and dental.
These benefits reset each year, generally either 1st of January or 1st of July.
Extras benefits do not typically roll over, so you should try and use them before they reset.
Extras benefits reset on 3 different dates: January 1st, July 1st, or the anniversary of your policy start date. This table lists the dates that each fund uses, as of October 2023.
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There are a few other extras cover limits you should be aware of.
- Waiting periods: All extras policies have a waiting period before you will be able to claim (with a few exceptions). This period is typically 2, 6 or 12 months, but can be as long as a few years for things like hearing aids or braces.
- Claim time limit: You need to make a claim within a certain time after you get a service. This time limit is typically 2 years.
- Service limit: There may be a limit on the number of times you can claim a benefit for the same service in a year. For example, you may be allowed to only claim 2 dentists appointments per year.
- Daily claim limit: Some health funds limit you to claiming one extras benefit per day. So if you receive multiple services within one consultation, you may only be able to claim the service which attracts the higher benefit.
Annual limits usually apply to a wide range of general treatments included in extras cover, such as:
However, there are certain parts of extras cover to which annual limits don’t usually apply, for example ambulance cover.
What is the difference between a combined limit and a sublimit?
When comparing extras cover, it’s important to be aware that sub-limits and combined annual limits may also apply. While your policy may have an annual limit of $1,000 for general dental services, there may also be a sub-limit that sets the maximum amount you can claim for a specific dental treatment, for example a routine checkup or a basic extraction. This sub-limit is subtracted from the larger annual limit.
However, combined annual limits may also apply. For example, your policy may provide up to $300 cover for each of the following services: physiotherapy, chiropractic treatment and osteopathy. However, those services may also be grouped together into one category with a combined annual benefit limit of $750 – so the maximum yearly amount you can claim for all the physio, chiro and osteo services you receive is $750.
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